NDDN Committee Report

RECOMMENDATION 1

The Minister of National Defence and the Chief of the Defence Staff should jointly make a public announcement to all ranks of the Canadian Forces, outlining a high-profile effort to pursue a modern, enlightened and unequivocal view of mental health issues in the Canadian Forces. All commanders of commands, formations and units should also deliver complementary declarations to their personnel, to reinforce implementation at the local level.

RECOMMENDATION 2

The Department of National Defence should cause an independent audit to be conducted of military patient case management practices to determine the extent to which a gap exists between expressed Canadian Forces policy and the actual practices applied to the continuing treatment and care of injured Canadian Forces personnel. Once defined, appropriate measures should be taken, throughout the chain of command, to eliminate the gap and improve patient care.

RECOMMENDATION 3

The Department of National Defence should cause a second audit to be conducted by an independent body, to examine the administrative burden imposed on Canadian Forces health professionals, with a view to determining whether any such administrative duties adversely impact the delivery of effective patient care.

RECOMMENDATION 4

It is recommended that Government recognize, despite the shortage of healthcare professionals in Canada, that the Canadian Forces has an obligation to provide necessary and adequate medical treatment to its members including returning soldiers with continuing need for treatment and services.

Just as the Canadian Forces is expected to provide treatment for physical injury, the Canadian Forces should also be expected to provide soldiers suffering from OSI with the necessary mental health and related services. Related services include, but are not limited to, addictions counselling, marriage and family counselling, occupational therapy and recreational therapy.

Recognizing that the Canadian Forces cannot implement effective remedies alone, a strategy for providing adequate and comprehensive treatment for OSI will require cooperation and support from other government departments. But regardless of the challenges, the Canadian Forces—with assistance from the appropriate government partners—must make every effort to mobilize, deploy and sustain sufficient mental health and related professionals to meet the needs of members of the Canadian Forces and their families.

RECOMMENDATION 5

It is recommended that the Government establish, within one year of the presentation of this report, a National Health Care Resources Monitoring Council, led by Health Canada, composed of health representatives from the Canadian Forces, the Royal Canadian Mounted Police, other appropriate government departments and agencies, other appropriate levels of government and other relevant stakeholders. This Council should meet regularly, at least semi-annually, to review the disposition of all health care capabilities in Canada, review health care needs in various client communities such as the Canadian Forces and military families, identify gaps and consult on measures that could be taken to remedy them.

RECOMMENDATION 6

It is recommended that Health Canada, supported by the Department of National Defence and Veterans Affairs Canada, complete a detailed audit of health care services available to the Canadian Forces in Canada and around the world, to identify the nature and scope of gaps. In Canada, this would be done in cooperation with provincial, territorial and appropriate municipal authorities. The Committee recommends particular attention be paid to large rural bases, which seem most at risk for lack of health infrastructure. Abroad, it would be done in cooperation with nations in which Canadian Forces personnel are located.

RECOMMENDATION 7

The Canadian Forces should expand recruitment incentive programs for mental health professionals, including the use of student debt relief, grants, bonuses, tuition payment and the purchase of more medical placements at universities, providing provincial assurances can be gained that the money so spent would indeed go to educate nominated Canadian Forces mental health care students.

RECOMMENDATION 8

The Canadian Forces should include treatment for substance abuse and addictions as part of the services offered to sufferers of OSI and PTSD.

RECOMMENDATION 9

The Canadian Forces should ensure that members and their families are provided with information about the risk of domestic violence that is associated with OSI and PTSD, and should provide services to family members who are at risk of or suffering from domestic violence as a result of OSI or PTSD.

RECOMMENDATION 10

The Canadian Forces should develop a formal outreach program to educate contracted health care professionals about the unique nature of military experiences encountered on international missions, particularly those involving any degree of combat.

RECOMMENDATION 11

The Canadian Forces should formally recognize the requirement to include, where appropriate, selected family members in the treatment regime of psychologically injured personnel and take measures to ensure they are consulted and included in treatment plans, to the extent it is helpful to do so.

RECOMMENDATION 12

Where injured Canadian Forces members require continuing assistance in navigating an administratively complex programme of treatment and care, the Canadian Forces should facilitate the use of a designated advocate chosen by the member and provide an appropriate level of cooperation with such advocate. Canadian Forces members should be advised of their right to an advocate. Given the concerns of additional stresses on family members, potential advocates could include retired members of the Canadian Forces and other professionals (e.g. medical doctors, psychologists, spiritual/religious advisors).

RECOMMENDATION 13

The Canadian Forces should give primary consideration to the continuity of quality care for recovering soldiers, over career development options.

RECOMMENDATION 14

The Canadian Forces should monitor the mental health of its members for five years after deployment on operational missions, to ensure effective treatment and tracking of mental health issues.

RECOMMENDATION 15

The Canadian Forces must recognize there still exists a certain culture, perhaps even a prejudice, regarding how mental illness is perceived among its rank and file.

RECOMMENDATION 16

The Canadian Forces should continue its efforts to educate all military personnel on the nature, processing and treatment of OSI, with a particular effort to eliminate any stigma associated with the condition.

RECOMMENDATION 17

The Canadian Forces should embed in all leadership training courses, at all levels, material on identifying and processing personnel with OSI. Enhanced material, for commanders at all levels, should be included in all pre-deployment training too.

RECOMMENDATION 18

The Department of National Defence and the Canadian Forces should move to co-locate all medical facilities on military bases, in a manner that supports the concept that all injuries and ailments will be treated with equal respect and that works to eliminate any lingering stigma associated with mental health issues.

RECOMMENDATION 19

The Department of National Defence should ensure that adequate resources are allocated to the establishment of a sufficient number of the Joint Personnel Support Units and Integrated Personnel Support Centres to provide this level of support and service nation-wide.

RECOMMENDATION 20

Reserve unit chains of command must be intimately and proactively involved in ensuring their returning personnel complete the post-deployment process on time, including all necessary administration, interviews and medical appointments. Where individual Reservists are undergoing continuing care and treatment after full-time service, Reserve unit chains of command must remain in regular contact with CFHS case managers and take an active interest in the soldier’s treatment programme.

RECOMMENDATION 21

The Canadian Forces must continue their efforts to inform and educate military members and their families about the nature and treatment of OSI, but with an enhanced focus on Reserve Force commanders, personnel and their families, particularly those who reside at some distance from a military installation.

RECOMMENDATION 22

The Committee encourages the Minister of National Defence and the Canadian Forces to continue to strive for the compassionate application of existing regulations regarding universality of service and minimum operational standards, to allow the continued employment of recovering soldiers, as long as such employment contributes to Canadian Forces operational requirements.

RECOMMENDATION 23

The Department of National Defence should immediately provide enhanced transportation resources (such as modern multi-passenger vans or highway cruiser buses and drivers) to isolated military bases to ensure that military personnel and family members have adequate transportation for access to out-of-town health care services and medical appointments.

RECOMMENDATION 24

The Canadian Forces has an obligation to remind personnel that they have an obligation to keep their families fully informed of medical and social support services available to them. The Canadian Forces must continue to encourage military families to engage those medical and social support services.

RECOMMENDATION 25

In conjunction with other Federal Healthcare Partnership stakeholders, the Department of National Defence, Veterans Affairs Canada and the Canadian Forces should hold an annual national conference on best practices and advancements in military health care overall, with special emphasis on mental health care.

RECOMMENDATION 26

The Canadian Forces should ensure that personnel in units returning from operational tours of duty are exempt any further non-operational deployment away from their unit for the defined duration of the
post-deployment reconstitution phase, unless to do so would negatively affect patient well-being according to mental health professionals.

RECOMMENDATION 27

The Canadian Forces should ensure continuity in the chain of command in units returning from operational tours of duty, particularly at lower levels, remains in place, as much as operational requirements allow, during the post-deployment reconstitution phase.

RECOMMENDATION 28

The Canadian Forces should develop health services doctrine to cover the care and treatment of Canadian Forces casualties from the point of evacuation to recovery or release and transfer to Veterans Affairs Canada support.

RECOMMENDATION 29

The Canadian Forces should ensure their extended health services doctrine includes measures addressing OSI from recruitment through to retirement, with particular emphasis on the preparation of soldiers to endure psychological traumas before they engage in combat operations. The Canadian Forces should investigate best practices in psychological preparation for OSI and PTSD.

RECOMMENDATION 30

The Department of National Defence and the Canadian Forces should institute a program, in concert with Provincial and Territorial governments, to monitor best practices for the cooperation and integration of Canadian Forces health services with local community health and social services, and implement common high standards.

RECOMMENDATION 31

The Canadian Forces should ensure that a military padre or contracted religious/spiritual advisors are available at any third location decompression centre and are included in the Canadian Forces strategy on mental health care.

RECOMMENDATION 32

The Canadian Forces should regularly review the composition of the Operational Trauma Stress Support Centre multi-disciplinary teams and remain open to the addition or use of clinical professionals not traditionally found in the military health care system, such as registered marriage and family therapists and that the services thereof be added to the dependents’ Extended Health Care schedule of covered benefits.

RECOMMENDATION 33

The Canadian Forces should provide this Committee, the Auditor General of Canada and the Department of National Defence and Canadian Forces Ombudsman with a full, unclassified update of the status of the Canadian Forces Health Information System, along with a meaningful explanation of when it will reach full operational capacity.

RECOMMENDATION 34

The federal government should move immediately to provide the necessary resources to reach full operational capability of the Canadian Forces Health Information Systems project, with the assistance of a database.

RECOMMENDATION 35

The federal government should initiate cooperative programs with provincial and territorial governments, to offer incentives to qualified professional health care workers, to provide their services to Canadian Forces personnel and their families, in locations where there is a shortage of such services.

RECOMMENDATION 36

The federal government should continue to work in cooperation with provincial and territorial governments to enhance relationships between local community health and social services to enhance and Canadian Forces health care services.